LARS韧带在前交叉韧带重建中的临床应用与关注热点

文题释义： LARS韧带：于1985 年由法国Dr.Laboureau 应用聚对苯二甲酸乙二醇酯材料模仿人体韧带的解剖结构和生物力学原理设计而成。近年来因其出色的生物相容性和力学特性，被较多的应用于膝关节前交叉韧带损伤后的重建。 前交叉韧带重建：前交叉韧带是维持膝关节稳定的重要结构，整个韧带的纤维束从股骨向胫骨近似扇形散开，内部纤维束以特定的排列方式从前向后分布。目前大多数学者主张将前交叉韧带分为2束，根据其在胫骨附着的相对位置分为前内侧束及后外侧束。由于膝关节前交叉韧带自身的解剖学特性，其完全断裂后无法自行修复，若不及时进行手术治疗往往造成半月板及关节软骨的损伤，因此如果诊断明确，应及早行前交叉韧带重建，用新的移植物替代损伤的前交叉韧带。 背景：虽然目前重建前交叉韧带的移植物选择包括自体移植物、同种异体移植物和人工合成移植物3种主要类型，但移植物的选择仍是当今的热门研究以及争议点的所在。 目的：综述LARS韧带在关节镜下前交叉韧带重建中的早期、中期以及长期临床疗效的国内外研究现状。 方法：应用计算机检索CNKI数据库、PubMed数据库的2019年4月前发表的相关文献，检索词为“LARS韧带，前交叉韧带，人工韧带，前交叉韧带重建，LARS ligament，anterior cruciate ligament，artificial ligament，anterior cruciate ligament reconstruction”。通过阅读文章标题和摘要进行初步筛选，排除与文章主题不相关的文献，根据纳入和排除标准最终纳入46篇文献进行综述。 结果与结论：①LARS韧带拥有出色的生物相容性和力学特性，它的独特结构使成纤维细胞包裹、穿透似生长，且韧带周围没有炎性反应，巨噬细胞少，由于长入的组织增加了韧带的黏弹性且减少了纤维间的摩擦，可有效防止碎屑引起的生物反应；LARS人工韧带弹性模量好，抗扭转、抗疲劳性强；②LARS韧带重建前交叉韧带具有快速康复、低失败率和低并发症等优点，表明LARS韧带适用于前交叉韧带重建。 ORCID: 0000-0001-7923-9839(陈伟) 中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

Clinical application and focus of LARS ligament in anterior cruciate ligament reconstruction

BACKGROUND: Although there are three main types of graft selection for anterior cruciate ligament reconstruction:autograft, allogeneic graft and synthetic graft, graft selection is still the focus of current research and controversy.OBJECTIVE: To review the early, mid-term and long-term clinical effects of LARS ligament in the reconstruction of arthroscopic anteriorcruciate ligament.METHODS: The related literatures published before April 2019 in CNKI database and PubMed database were searched by computer with thesearch terms “LARS ligament, anterior cruciate ligament, artificial ligament, anterior cruciate ligament reconstruction” in Chinese and Englishrespectively. After preliminary screening by reading titles and abstracts, irreverent literatures were excluded. Forty-six eligible literatures wereincluded.RESULTS AND CONCLUSION: LARS ligament had excellent biocompatibility and mechanical properties. Its unique structure allowed fibroblaststo grow in the forms of wrapping and penetration, and there was no inflammatory reaction around the ligament and fewer macrophages wereobserved. Because the growing tissue increased the viscoelasticity of the ligament and reduced the friction between the fibers, so it can effectivelyprevent the biological reaction caused by detritus. LARS ligament had good elastic modulus, anti-torsion and fatigue resistance properties. LARSligament was suitable for anterior cruciate ligament reconstruction because of its rapid recovery, low failure rate, and few complications.